Functional connectivity response to distress-inducing auditory feedback associated with short-term smoking abstinence

The insula helps regulate affective distress and plays a critical role in maintaining tobacco use disorder. Task-based functional connectivity underlying cognitive performance during affective distress has previously distinguished between current smoking and long-term ex-smoking behavior. In the current study, we investigated whether individual differences in distress-related functional connectivity corresponded to short-term quit attempt outcomes.

Participants performed a distress tolerance task while undergoing magnetic resonance imaging and planned a quit attempt a few days later. Participants completed five follow-up visits across 10 weeks to verify smoking status. Participants were then grouped based on quit outcomes (e.g., ≥ 7 consecutive days Abstained n = 13, ≥ 7 days Reduced cigarettes/day n = 18, or Smoked n = 27).

In the right anterior insula and left posterior insula, there was a stepwise pattern of distress-related connectivity across groups (Abstained < Reduced < Smoked). The Smoked group had the strongest positive distress-related connectivity and this was associated with their negative mood and task accuracy.

Stronger distress-related connectivity with the insula may represent increased cognitive-affective effort needed to tolerate distress during cognitive performance. The relationship across Abstained, Reduced, and Smoked groups suggests this measure of distress tolerance plays a role in the ability to quit smoking. This insula connectivity could be a modifiable target for neuromodulation to help reduce the cognitive-affective effort needed to refrain from smoking during stress-induced craving.